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S , IMNILN6 PoOL OFFICIAL INk rA..i YoR <br />SAN JOAQUIN CO CNTY PUBLIC HEALTH SERVICES <br />ENVU MENTAL HEALTH DIVISION <br />304 EAS'i WEBER AVENUE, THIRD FLOOR <br />STOCKTON, CA 95202 <br />(209) 468-3420 <br />BUSq+IESS ADDRESS <br />DATE <br />OWNER'S NA.A4E,DBA <br />COMPUTER niumeER <br />MAILING ADDRESS <br />TIME trl <br />PERMIT/LICENSE PPOGRAmitLEmENT SERVICE TIME DUE <br />RATE OF FLOW CL Th.,. OIRtli RECIRCULATION EQUIPMENT] SIR OPEN <br />Filters <br />Pumps <br />Chlorinator <br />Flowmeter <br />Gauges <br />Skimmer & Gutters <br />Back Flow Prevention <br />Waste Water Prevention <br />Water Supply & Quality <br />Pipe & Fittings <br />1 2 <br />3 4 <br />5 6 <br />7 8 <br />9' 10 <br />11 12 <br />13 14 <br />15! 16 <br />17. 18. <br />19. <br />M20 <br />V t) CON- STRUCTION. Pool Shell <br />Bottom & Slides <br />Decking & Coping <br />Diving Boards <br />21' . 22 , <br />23 24 <br />25 26. 1 SAFETY EQUIPMENT Rebore Pole <br />Lilo Rings <br />Satiety Signs <br />' Lifeguard <br />Lighting Elec. <br />Ladders <br />' Depth Markers <br />First Aid Kits <br />-Gas Masks <br />27! 28. <br />29 30. ' <br />31 32' 1 <br />1 433 , <br />34 , 35 <br />36' 37 <br />38 39 <br />40: 41 <br />42, 43 <br />V) i--5 cry.-Luc) <br />cc0 <br />cc <br />Shower, <br />Toilet & Dressing <br />Ventilation <br />44, 45 <br />46' 47 <br />48, 49. POOL I QUALITY Chlorine <br />pH <br />Cyanuraies <br />Clarity <br />Test Kits <br />50 <br />51 . ! <br />52' <br />53. <br /> <br />cc <br />Ill <br />I <br />I-C-S <br />Suoorvislon & Control <br />General Sanitation <br />Miscellaneous <br /> <br />513 <br />57. <br />POOL <br />En <br />58 <br />STATUS: <br />G <br />59 <br />(MARK <br />F <br />60 <br />ONE) <br />P <br />61 <br />C <br />62 <br />— <br />py,,,.., • r),,,..,.4) <br />The marked iterns represent Health Code violations and must be correcttz,L as <br />follows: <br />RECEIVED EIT <br />EXVIkUmgcollAl heALTM SPtiC/WLIST <br />PAGE OF